Primary neck management among patients with cancer of the oral cavity without clinical nodal metastases: A decision and sensitivity analysis

Head Neck. 2002 Jun;24(6):582-90. doi: 10.1002/hed.10101.


Background: A standardized neck management strategy for oral cancer patients without clinical nodal metastases remains to be established. Consequently, a decision and sensitivity analysis of two neck management protocols, involving either prophylactic neck dissection or careful observation, was conducted using the Oral Cancer Registry of Kyushu, Japan.

Methods: We calculated probabilities of subclinical nodal metastases and 5-year survival using the registry data. A two-way sensitive analysis was conducted using the probabilities and parameters of the complete nodal metastasis resection rate (x) and a utility rating that describes the health state induced by dissection (y) compared with the neck condition in a careful-observation group.

Results: We solved the threshold curve for y and x for the expected utility between the two groups. The results showed that prophylactic neck dissection must guarantee a complete resection of subclinical nodal metastases with no disadvantage to health state to be evaluated as equally satisfactory as careful observation.

Conclusions: Careful observation involving standardized systematic preoperative and postoperative screening of the neck seems preferable to prophylactic neck dissection for oral cancer patients without subclinical nodal metastases.

MeSH terms

  • Carcinoma, Squamous Cell / mortality
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / surgery
  • Decision Support Techniques*
  • Decision Trees
  • Humans
  • Lymph Node Excision*
  • Lymphatic Metastasis
  • Mouth Neoplasms / mortality
  • Mouth Neoplasms / pathology*
  • Mouth Neoplasms / surgery*
  • Palatal Neoplasms / mortality
  • Palatal Neoplasms / surgery
  • Tongue Neoplasms / mortality
  • Tongue Neoplasms / surgery